TY  - BOOK
AU  - Al-Refaie, Waddah B
AU  - Chan, Kitty
AU  - Crocker, Andrew B
AU  - DeLeire, Thomas
AU  - McDermott, James
AU  - Shara, Nawar M
AU  - Watson, Thomas J
AU  - Xiao, David
AU  - Zeymo, Alexander
TI  - Expansion coverage and preferential utilization of cancer surgery among racial and ethnic minorities and low-income groups
SN  - 0039-6060
PY  - 2019///
KW  - *Ethnic Groups
KW  - *Insurance Coverage
KW  - *Neoplasms/ep [Epidemiology]
KW  - *Patient Acceptance of Health Care
KW  - *Patient Preference
KW  - *Social Class
KW  - Adult
KW  - Female
KW  - Humans
KW  - Income
KW  - Insurance Coverage/sn [Statistics & Numerical Data]
KW  - Male
KW  - Medicaid
KW  - Middle Aged
KW  - Minority Groups
KW  - Neoplasms/su [Surgery]
KW  - Patient Protection and Affordable Care Act
KW  - Public Health Surveillance
KW  - United States/ep [Epidemiology]
KW  - MedStar Health Research Institute
KW  - Journal Article
N2  - BACKGROUND: The Affordable Care Act Medicaid expansion demonstrated inconsistent effects on cancer surgery utilization rates among racial and ethnic minorities and low-income Americans. This quasi-experimental study examines whether Medicaid expansion differentially increased the utilization of surgical cancer care for low-income groups and racial minorities in states that expanded their Medicaid programs; CONCLUSION: Medicaid expansion was associated with greater utilization of cancer surgery by low-income Americans but provided no preferential effects for racial minorities in expansion states. Beyond the availability of coverage, these findings highlight the need for additional investigation to uncover other factors that contribute to race-ethnic disparities in surgical cancer care; Copyright (c) 2019. Published by Elsevier Inc; METHODS: A cohort of more than 81,000 patients 18 to 64 years of age who underwent cancer surgery were examined in Medicaid expansion versus nonexpansion states. This evaluation utilized merged data from the State Inpatient Database, American Hospital Association, and the Area Resource File for the years 2012 to 2015. Poisson interrupted time series analysis were performed to examine the impact of Medicaid expansion on the utilization of cancer surgery for the uninsured overall, low-income persons, and racial minorities, adjusting for age, sex, Elixhauser comorbidity score, population-level characteristics, and provider-level characteristics; RESULTS: For persons from low-income ZIP codes, Medicaid expansion was associated with an immediate 24% increase in utilization (P = .002) relative to no significant change in nonexpansion states. No significant trends, however, were observed after the Affordable Care Act expansion for racial and ethnic minorities in expansion versus nonexpansion states
UR  - https://dx.doi.org/10.1016/j.surg.2019.04.018
ER  -